Abstract
BACKGROUND: Vertebral fractures identified by radiographic morphometry are associated with increased mortality risk. However, there is limited data regarding the association between vertebral fractures detected by lateral spine dual energy X-ray absorptiometry (DXA) scans and the risk of mortality. METHODS: The present study was based on data from participants aged 40 years and older in the 2013 to 2014 cycle of the National Health and Nutrition Examination Survey (NHANES). Vertebral fracture assessment (VFA) performed using lateral spine DXA scans was used to provide fracture information of the vertebrae from T4 to L4. Vertebral fracture severity was categorized according to Genant's semiquantitative technique and the NHANES 2019 public-use linked mortality files were used to determine mortality status. RESULTS: Of 3,219 participants, the prevalence of vertebral fractures identified by VFA was 5.5% (95% confidence interval [CI], 4.7-6.5). During a median follow-up of 71.0 months, 277 participants died, 18.2% (95% CI, 12.2-26.3) with vertebral fractures and 6.3% (95% CI, 5.0-8.0) without fractures (p<0.0001). Cox regression analysis demonstrated that participants with moderate to severe vertebral fractures (>25% height loss) were 1.7 times more likely to die compared with their counterparts without (hazard ratio [HR], 1.79; 95% CI, 1.05-3.04). Notably, in a subgroup analysis, older adults (HR, 2.16; 95% CI, 1.41-3.30) and men with vertebral fractures (HR, 2.28; 95% CI, 1.49-3.47) had a 2-fold greater mortality risk compared to those without vertebral fractures. CONCLUSIONS: Vertebral fracture severity identified by VFA was significantly associated with greater all-cause mortality risk. This association was also observed among men and older adults with any baseline vertebral fractures.